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HealthCert Education > Difficult benign lesions > Flashcards

Difficult benign lesions Flashcards

1
Q

Dermoscopy accuracy in melanoma detected: NNE

A

Using Dermoscopy 8.7

Not using Dermoscopy 29.4

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2
Q

4 main simulators of melanoma

A
  1. Melanoma-like nevi
  2. Melanoma-like seb keratosis
  3. Spitzoid looking lesions.
  4. Nevi with special features.
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3
Q

Strategies to reduce biopsies

A
  1. Tape stripped of dark nevus.

2. Take into account patient related factors.

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4
Q

Skin type vs typical pigmented melanocytic nevi.

A

Fitz type
I: Light brown, central hypopigmentation
II: Light brown, multifocal hyper or hypopigmentation.
III: As above
IV: Dark brown. Central hyperpigmentation.

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5
Q

Dermoscopic island definition

A

Dermoscopic area that differs from the remaining lesion.

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6
Q

Dermoscopic island - common patterns

A

Reticular
Globular
Homogenous
Starburst

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7
Q

What % of MIS, melanoma, and atypical nevi contain a dermoscopic island.

A

MIS: 10.4
Melanoma: 4.1%
Atypical nevi: 3.1 %

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8
Q

Dermoscopic island: Odds ratio for melanoma.

A

1.9

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9
Q

Dermoscopic island: Specificity for melanoma.

A

96.9%

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10
Q

Dermoscopic island - invasive melanoma with this features is …

A

thinner

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11
Q

What % of melanoma with dermoscopic island arise in nevus?

A

50%

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12
Q

What can you use to distinguish between nevus and melanoma in presence of dermoscopic island?

A

Conflocal microscopy

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13
Q

Lesions with regression - blue white structures. Rule for excision.

A

BW lesions > 50% of lesion - excise

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14
Q

Sclerosing nevus with psuedomelanomatous features: clinical presentation

A

Young adults, middle aged

Typical located on Convex area of Back.

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15
Q

Sclerosing nevus with psuedomelanomatous features: Dermoscopy

A

Polychromatic with both white and blue regression like fibrosis.

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16
Q

Melanoma-like seborrheic keratosis: What % of excised tumour are SK?

A

3.8%

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17
Q

Melano-acanthoma

A

Striking pigmentation in tne centre.

Typical features of seborrheic keratosis at the border

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18
Q

Features of SK: Dermoscopy

A 
Sharply demarcated border. jelly like
Brown color
Fat finger
Cerebriform pattern
Comedo like openings
Vessels with white surround
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19
Q

Clonal seborrheic keratosis, histopath

A

Sharply demarcated intra-epithelial nests of basaloid or pale cells.
In some cases nests composed of larger cells with conspicuous intercellular bridges and are separated by strands of cells with small dark nuclei.

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20
Q

Clonal seborrheic keratosis, distribution and epidemiology

A

head and neck
followed by trunk and extremities
first 3 decades of life

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21
Q

Clonal seborrheic keratosis, clinical

A

flat to slightly palpable pigmented lesions ranging in colour from light brown to dark brown and revealing sharply demarcated borders.

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22
Q

Clonal seborrheic keratosis, Dermoscopy

A

large globular like structures and bluish globular like structures with a more pronounced pigmentation in the centre resembling the so called “concentric” structures of BCC

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23
Q

Clonal seborrheic keratosis, role of confocal microscopy

A

Can help to identify the nests

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24
Q

Spitzoid looking lesions - major groups

A

Children < 12

Adults

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25
Spitzoid, pattern in children < 12
Amelanotic pattern with dotted vessels Starburst Globular
26
Spitzoid nevus in children, management
Flat - follow up | Nodular - excise
27
Desmoplastic spitz nevus clinical
Reddish appearance of nodules or plaque
28
Angiomatous spitz nevus clinical
Reddish colour
29
Verracous spitz nevus clinical
Raised lesion, verrucous
30
Likelihood of finding melanoma in symmetric spitzoid looking tumour by age
> 11. 13.3% | >50. 50%
31
Management decision for Spitz Nevi > 11 years old
Excise
32
Does confocal microscopy play role in differentiation spitz nevi from melanoma
Only in flat lesions with starburst and globular pattern.
33
Nevi with special features
``` Balloon cell nevus Targetoid hemosiderotic nevus Meyerson nevus Sutton or Halo nevus Recurrent nevus Combined nevi ```
34
Balloon cell nevus: Histopath
Predominance or complete occurrence of large vesicular clear cells, called balloon cells.
35
Balloon cell nevus: Distribution
Head and neck followed by trunk and extremities
36
Balloon cell nevus Clinical
Generally brown, may appear as smooth papule, may be polypoid
37
Balloon cell nevus Dermoscopy
Numerous aggregated white/yellow globular structures that correspond to balloon cell nevi nests.
38
Ballon cells, definition
Melanocytes with pale-staining and vacuolated cytoplasm which often has a defect in melanosome formation
39
Targetoid hemosiderotic nevus: Definition
Characterized by violaceous eccymotic halo
40
Targetoid hemosiderotic nevus: Also known as ..
Traumatized nevus
41
Targetoid hemosiderotic nevus: Pathogenis
Hemorrhage dt trauma
42
Targetoid hemosiderotic nevus: Clinical
Nodular pre-existing nevus with sudden color change and violaceous hue.
43
Targetoid hemosiderotic nevus: Dermoscopy
Mostly globular or structureless brown pattern superimposed by structureless red to purple to black areas and violaceous hue.
44
Targetoid hemosiderotic nevus represent exception to rule .....
to not follow ip doubtful palpable lesions | very short term monitoring - 2 weeks.
45
Meyerson nevus: Definition
development of eczematous halo around one or more pigmented nevi
46
Meyerson nevus: Epidemiology
Any age, more frequent young health adults
47
Meyerson nevus: Clinical
Erythematous halos with overlying scales sometimes accentuated at periphery of erythematous zones.
48
Meyerson nevus: Dermoscopy
Yellowish overlying superficial serocrust
49
Meyerson nevus: Confocal microscopy features
Spongiotic vessels
50
Sutton or Halo nevus: definition
surrounded by achromic rim that simulates a halo.
51
Sutton or Halo nevus: epidemiology
Usually appear in children or young adults. | Average age onset 15 years.
52
Sutton or Halo nevus: Association
Associated with atopic dermatitis or autoimmune disorders such as vitiligo or Hashimoto thyroiditis
53
Sutton or Halo nevus: Dermoscopy
Central globular or homogenous pattern surrounded by variable rim of a white regression-like depigmentation.
54
Sutton or Halo nevus: Outcome
Nevus tends to disappear
55
Recurrent nevus: Definition
Benign melanocytic nevus that regrow following incomplete surgical excision or trauma.
56
Recurrent nevus: Clinical
Macular area of scar with variegated hyperpigmentation, and hypo pigmentation, linear streaking and halo, stippled, and or diffuse pigmentation
57
Recurrent nevus: Dermoscopy
Benign recurrences are confined to the scar, arising in the centre of the scar and extending within the scar.
58
Recurrent nevus: Parameters to evaluate
1. Time: Rapid development likely benign. Months to years may be melanoma. 2. Pigment distribution. Within scar, centrifugal or in lines perpendicular likely benign. From edge of scar invading surrounding skin likely malignant. 3. Dermoscopy. Confined within scar - benign.
59
Recurrent melanoma, as opposed to recurrent nevi, are more frequently found on ....
Head and neck.
60
Combined nevi: Definition
histopathological presence of two different types of melanocytic proliferations within the same nevus
61
Combined nevi: Most frequent combination.
Blue nevus with Spitz, acquired or congenital melanocytic nevus
62
Combined nevi: Dermoscopy
Colour variegation or more than one structure.

HealthCert Education (24 decks)

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